PURPOSE: Various tumor markers, developed recently for the diagnosis of bladder cancer, are reported to be superior to urine cytology in terms of their sensitivity and non-invasiveness. A prospective study was performed to evaluate the efficacies of BTA TRAK, BTA stat, NMP22 tests and urine cytology. MATERIALS AND METHODS: Between August 2001 and December 2001, 154 patients were involved in the study. Voided urine was used to perform BTA TRAK, BTA stat, NMP22 tests and cytology. The final diagnoses were pathologically proven transitional cell carcinoma (TCCa) of the bladder in 34 patients, gross or microscopic hematuria without detectable tumor in 27, history of TCCa without evidence of recurrence in 68 and benign urologic diseases in 25. RESULTS: The sensitivities of the BTA TRAK, BTA stat, NMP22 and urine cytology were 82.4, 79.4, 61.8 and 32.4%, respectively. The specificities were 75.8, 70.8, 95.8 and 92.5%, respectively. When the sensitivity was subdivided according to the tumor stage, grade and size, the bigger size yielded higher sensitivities in the NMP22 and BTA TRAK (p<0.01 and p=0.03, respectively). When the results of the urine cytology were combined with each of the other tests, the specificity was lower than each test alone for the BTA TRAK and BTA stat, while sensitivity and specificity were both higher than each test alone for the NMP22. CONCLUSIONS: The BTA TRAK, BTA stat and NMP22 tests are useful in overcoming the limitations of cystoscopy and cytology as the initial evaluation tools for patients where bladder cancer is suspected. In particular, the NMP22 may be more useful due to its enhanced specificity when combined with the urine cytology.
Carcinoma, Transitional Cell ; Cystoscopy ; Diagnosis* ; Hematuria ; Humans ; Prospective Studies ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urologic Diseases

Primary localized amyloidosis of the urinary tract is very rare disease. A 72-year-old man, with a history of urethral injury, had a stricture of the anterior urethra about 6cm in length. A segmental resection of urethra and urethroplasty, with penile skin flap, was performed. The resected urethral segment was diagnosed as urethral amyloidosis. There was no involvement of amyloidosis oin the other organs (heart, gastrointestinal system, joint, kidney, skin etc) and no underlying disease (multiple myelomas, rheumatism, cancer, chronic inflammation etc). Also, a 75-year-old woman, with a history of intermittent gross hematuria, had a stricture of the lower ureter. During diagnostic ureteroscopy, there was an irregular mucosal change of her lower ureter. An intraoperative biopsy showed ureteral amyloidosis. Here, we report on these two cases of primary amyloidosis of the urinary tract.
Aged ; Amyloidosis* ; Biopsy ; Constriction, Pathologic ; Female ; Hematuria ; Humans ; Inflammation ; Joints ; Kidney ; Rare Diseases ; Rheumatic Diseases ; Skin ; Ureter ; Ureteroscopy ; Urethra ; Urinary Tract*

A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.

Renal angiomyolipomas are benign mixed mesenchymal tumors, which are composed of atypical blood vessel, smooth muscle and fat cells. A 34-year-old woman presented with a palpable right abdominal mass, accompanied with discomfort. A CT scan showed a large right perinephric mass, with heterogeneous density, surrounding the kidney, with enlargement of the regional lymph nodes. The presumptive diagnosis was one of a malignant tumor of the retroperitoneum, with lymph node metastasis or an angiomyolipoma, involving both the kidney and lymph nodes. A right radical nephrectomy, including the tumor, was performed. The final diagnosis was an angiomyolipoma arising from the kidney, with the dissected lymph nodes having the same pathology. There was no evidence of a tumor recurrence during the six month follow-up period. This was an unusual case of a multicentric angiomyolipoma.
Adipocytes ; Adult ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Kidney ; Lymph Nodes* ; Muscle, Smooth ; Neoplasm Metastasis ; Nephrectomy ; Pathology ; Recurrence ; Tomography, X-Ray Computed

PURPOSE: To assess the toxicity and tumor response induced by DCVac/IR(R) dendritic cell (DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases. MATERIALS AND METHODS: Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of 6x10(6) DCs were packed into a vial (DCVac/IR(R), 0.5 ml) at the convenience of each patient's schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses (3x10(6) to 12x10(6) DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria. RESULTS: Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The 12x10(6) DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively. CONCLUSION: The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The DCVac/IR(R) immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials.
Appointments and Schedules ; Colorectal Neoplasms ; Consent Forms ; Dendritic Cells ; Ethics Committees, Research ; Humans ; Immunization ; Immunotherapy ; Liver ; National Cancer Institute (U.S.) ; Needles ; Neoplasm Metastasis ; Radiation Dosage ; Vaccination

BACKGROUND: Oxidative stress might be a role in atherosclerosis and increased intake of antioxidant appear to be protective and modify neointimal formation. An antioxidant and probucol prevents endothelial dysfunction and low density lipoprotein oxidation and also inhibits the secretion of cytokine by macrophages. We aimed 1) to study the effects of antioxidant (Vitamin C, E and probucol) supplementation on serum level of antioxidant status (TAS), P-selectin, MCP-1, IL-6 and IL-10 and 2) to investigate the effects of antioxidant intake on in-stent restenosis. METHODS: Total 90 patients were assigned to control or antioxidant group (probucol; 500 mg, vitamin C; 1,000 mg, vitamin E; 400 mg). We performed follow up coronary angiography in 35 patients of antioxidant group and 36 patients of control group after 6 months of coronary bare metal stent implantation. We counted the stenotic lesions more than 50% of implanted stent lumen as a restenosis by quantitative coronary angiography. The serum levels of total antioxidant status, P-selectin, MCP-1, IL-6 and IL-10 were measured. RESULTS: The serum levels of total antioxidant status was not elevated in antioxidant group. Antioxidant supplementation did not change the serum levels of P-selectin, MCP-1, IL-6 and IL-10. The 6-month angiographic in-stent restenosis rate was 27% versus 30% (p=NS) with an associated late loss of 0.76+/-1.01 mm versus 0.91+/-1.00 mm (p=NS) for antioxidant group and control group. The serum levels of total antioxidant status did not correlate with the restenosis or late loss after stent implantation. CONCLUSIONS: Vitamin C, E and probucol did not elevate the serum level of antioxidant status and could not prevent in-stent restenosis after bare metal stent implantation.
Antioxidants ; Ascorbic Acid ; Atherosclerosis ; Coronary Angiography ; Coronary Restenosis ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-10 ; Interleukin-6 ; Lipoproteins ; Macrophages ; Oxidative Stress ; P-Selectin ; Probucol ; Stents ; Vitamin E ; Vitamins

The algorithms and guidelines are a synthesis of current scientific evidences with clinical issues of safety and tolerability. It is inevitable that pharmacological strategies of psychiatric treatment have to be based on evidence-based medicine. The first Korean Medication Algorithm for Bipolar Disorder was developed from the information and opinions gathered by wide surveys to Korean psychiatrists and then, in the first time, its feasibility study was done. The problems on appropriateness of the shift of step, full education of algorithm administration and procedure before implementation, and easy applicability of measuring scales were found. These problems must be fully considered for algorithm implementation in the near future. Rapid updates on new evidences of therapeutic effects of drugs and recent trends of diagnostic concepts about bipolar disorder may justify revision of the medication algorithm. Especially, addition of widespread use of novel antipsychotics in all phases of illness, evidences of new anticonvulsants' effects, and change of strategies in the acute depression and maintenance treatments will have to be considered. Moreover, modification of questionnaire for algorithm revision will be needed in the aspect of easy implementation.
Antipsychotic Agents ; Bipolar Disorder* ; Depression ; Education ; Evidence-Based Medicine ; Feasibility Studies ; Psychiatry ; Surveys and Questionnaires ; Weights and Measures

OBJECTIVES: The primary aim of this study was to determine whether 18F-FDG-PET/CT (PET/CT) scans provide additional diagnostic information in addition to the direct laryngoscopic examination (L/E) and contrast-enhanced CT (CT) in patients with glottic cancer during the initial evaluation. METHODS: Fifty-five consecutive patients with glottic cancer of the larynx that had L/E, CT and PET/CT were enrolled. The diagnostic value of each modality was compared for their accuracy in predicting the extent of the primary tumors on sub-site based analysis and the final tumor staging. The reference standards were either the surgical pathology findings or clinical/radiological follow-up outcome. Changes in patient care based on PET/CT results were compared with the treatment decisions based on L/E with CT. RESULTS: For primary tumor sub-site based analysis, the sensitivity was significantly higher for L/E (92.8%) than for PET/CT (79.4%, P=0.028). The comparisons between L/E vs. CT and CT vs. PET/CT did not reach statistical significance. As an initial tumor-staging method the L/E had a diagnostic accuracy of 76.4%, compared to 61.8% for CT and 41.8% for PET/CT. The L/E and CT were better than the PET/CT (P=0.0009 and 0.049) for the initial TNM staging. PET/CT scanning changed the clinical decision-making based on the L/E with CT results in 12.7% of cases, of whom 5.5% had no additional PET/CT related benefit. CONCLUSION: Conclusion. The results of this study showed that PET/CT imaging added no clinical information benefit compared to the L/E and CT for the initial evaluation of patients with glottic cancer.
Fluorodeoxyglucose F18 ; Follow-Up Studies ; Glottis ; Humans ; Laryngeal Neoplasms ; Laryngoscopy ; Neoplasm Staging ; Pathology, Surgical ; Patient Care ; Positron-Emission Tomography

OBJECTIVE: The Korean College of Neuro psychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder to aid clinical decisions. The purpose of this study was to assess the feasibility of Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) in clinical settings in Korea. METHODS: A total of 126 bipolar patients were enrolled at 17 centers. Among them, 92 patients were treated according to the algorithm. All subjects were assessed over a 4-month period. Prescribing investigators were able to change the recommended treatment strategies of the algorithm if necessary. RESULTS: Overall ratings were favorable, with investigators stating that the overall quality of this algorithm was "good" or "no need to revise". Of manic patients, the majority (79%) showed treatment response (YMRS improvement > or =50%) at the first stage. CONCLUSION: These results suggest that this algorithm can be useful in clinical practices. However, some problems should be solved in the next version of KMAP-BP.
Bipolar Disorder ; Humans ; Korea ; Psychopharmacology ; Research Personnel ; Schizophrenia

OBJECTIVE: The Korean College of Neuropsychopharmacology and the Korean Academy of Schizophrenia developed the Korean algorithm project for bipolar disorder to aid clinical decisions. The purpose of this study was to assess the treatment response and the tolerability in the feasibility testing of Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) in clinical settings. METHODS: A total of 126 bipolar patients were enrolled at 17 centers. Among them, 92 patients were treated according to the algorithm. All subjects were assessed over a 4-month period. Prescribing investigators were able to change the recommended treatment strategies of the algorithm if necessary. RESULTS: Most patients showed significant decreases (p<0.001) in symptoms measured by the Young Mania Rating Scale and the 17-item Hamilton Depression Rating Scale for Depression at both assessment point 1 (about 2 weeks) and 4 months. No significant changes in adverse events were noted between baseline and endpoint. CONCLUSION: These results suggest that the treatment based on KMAP-BP can be effective and well tolerated in clinical practices. Further research is planned to revise KMAP-BP.
Bipolar Disorder ; Depression ; Humans ; Research Personnel ; Schizophrenia